In addition to checking growth and health, administering immunizations and prescribing medications, pediatricians have something else on their to-do list: checking cholesterol levels in all children.
In November, a report from the National Heart, Lung and Blood Institute (NHLBI), endorsed by the American Acedemy of Pediatrics (AAP), put out new recommendations for cholesterol screening and treatment in children. These recommendations replace the 2008 recommendations from the AAP that recommend screening high-risk children, including those with a family history of early heart disease or high cholesterol and certain conditions such as obesity, high blood pressure or diabetes.
While much of the previous recommendations still stands, the revised recommendations include universal screening for all children between the ages of 9 to 11. The reason that this age range has been chosen is that cholesterol drops during puberty but then increases again as adolescents approach adulthood.
Why the change?
According to the NHLBI report, atherosclerotic cardiovascular disease (CVD), in which the artery walls thicken as a result of the accumulation of fatty materials such as cholesterol, is the leading cause of death in North Americans. While the true form of “atherosclerosis” is rare in childhood and adolescence, the risk factors and risk behaviors in childhood can accelerate the development of it.
Here are key points from the NHLBI report on why universal testing is needed:
-Approximately 30-60% of children with high cholesterol are missed with the current testing protocol, as many do not have reliable or accurate family histories to guide them.
-Studies show that children with abnormal lipid levels such as high cholesterol are at increased risk for CVD as adults
-Better identification and control of abnormal lipids in childhood should reduce CVD risk beginning in early adulthood. Of particular importance are those with heterozygous hypercholesterolemia (FH), a genetic condition of high cholesterol levels typically requiring medication to keep cholesterol levels down.
-When the original guidelines were made, the focus was on identifying children with high LDL (bad cholesterol). But now a new combined pattern of abnormal lipids associated with obesity includes normal to mild elevation of LDL, high Triglycerides (type of fat in blood stream) and low HDL (good cholesterol). This new pattern has also been shown to increase CVD risk in adulthood.
Reactions
There have been some not-so-favorable reactions to these new recommendations. In this news article, Dr. Chad Teeters, a cardiologist at the University of Rochester Medical Center, points out that testing will be expensive and provide little benefit unless children get on cholesterol lowering medication — with no evidence that such drugs will help long term.
Yoni Freedhof, MD who blogs at Weighty Matters doesn’t agree with universal testing either:
In medical school I was taught that over 90% of diagnoses can be made on the basis of history alone. Rather than recommending a blood test, how about recommending physicians take lifestyle histories and that way, instead of just focusing on those kids who are unfortunate and predisposed enough to be developing “adult” style chronic diseases at a frighteningly young age, we can focus on all kids, including those whose youth might still be protecting them against an awful lifestyle. Don’t those kids need help too?
I agree with Freedhof that prevention for all is key — and that it’s not beneficial to only counsel children (and their parents) with high cholesterol. Additionally, research shows that half of children with high cholesterol will have it as adults. So that means the other half won’t. So does it help (or hurt) to alarm those children who will grow out of their high cholesterol?
On the other hand, a high cholesterol may be the wake-up call some parents need to get on a healthier path and a select few will be glad to discover their child has a genetic condition (like FH) so they can act early.
What do you think of all of this? Do you want your child being screened for high cholesterol as early as age 9?
For those who want more details, see the testing recommendations below or go to the full report.
Review of the recommendations
What the numbers mean for children
Total cholesterol: Acceptable <170mg/DL, borderline 170-199, high >200
LDL: Acceptable <110, borderline 110-129, high >130
HDL: Acceptable >45, borderline 40-45, low <40
Triglycerides 0-9 years: Acceptable 75, borderline 75-99, high >100
Triglycerides 9-16 years: Acceptable 90, borderline 90-129, high >130
Birth to 2 years: no screening
2-8 years: no routine screening unless the child has:
-a parent, grandparent, aunt/uncle, or sibling with heart attack, chest pain, stroke, any cardiac surgery <55 years in males and <65 years in females.
-a parent with Total cholesterol ≥240 mg/dL
-diabetes, hypertension, BMI ≥95th percentile or smokes cigarettes
9-11 years: universal screening
12-16 years: no routine screening unless the child has:
– a parent, grandparent, aunt/uncle or sibling with heart attack, chest pain, stroke, cardiac surgery, sudden death at < 55 years in males, < 65 years in females
-a parent with TC ≥240 mg/dL
-other high risk conditions
17-21 years: Universal Screening
I would say routinely – no. But honestly, I don’t think doctors today do a great job of even really helping adults who are borderline at risk. At least, that is my experience. I have a total cholesterol of 200. A very high HDL but my LDL is a little too high too. I have a strong family history (dad had first heart attack at 53). To me, my numbers are not ideal but my doctor is dismissive. Tells me I’m “normal.” I’m going to see a cardiologist next year. I turned 40 this year and feel that I need to get a full assessment of my risk level.
My point is- I don’t think routine screening helps anybody unless the physician is proactive about the results and has a good solid understanding of potential risk.
I hope that makes at least *some* sense.
It makes total sense! The children diagnosed with abnormal should have close medical monitoring and see a dietitian. Studies show that when parents try to make changes to diet without help, it can negatively affect growth.
I think in your case, seeing a specialist is key. You are doing the right thing by seeing the cardiologist.
This is a very interesting post to me…I have high cholesterol, I was first tested in my early teen years because my father has FH (his first cholesterol screening when he was around 30 his total was over 500). As a teenager mine was in the 200s, can’t remember exactly where it started. I had it checked every few years and was never really able to have any affect on my numbers with diet/exercise changes. About 6 months after my last baby was born (my total was at about 280) I went on simvastatin and my numbers immediately decreased and have been great.
My children are now 7 and 4. Both are around the 2nd percentile for height and weight. My 7 year old is not even in a booster seat because she hasn’t reached 40 pounds yet…At what point do I go from trying to responsibly “fatten them up” to watching their fat intake so their cholesterol isn’t too high? And does it really matter because if it is genetic will diet changes help or will they both eventually go medicine too? Both kiddos are tiny because my husband and I are/were tiny as children. When I had my first cholesterol tests I probably was about 4 ft. tall and weighed about 60 pounds, but had a total cholesterol of over 200.
I am not sure whether I would opt to get either one screened before age 11 because I think I would rather they have higher cholesterol and benefit from the fat and calories that they need to grow since they are both going to be tiny.
Hi Darcy — those are good questions. I would recommend you talk to a specialist about it and get some feedback. It might be good to know if their levels are really high — or that they don’t have a problem at all. Low fat diets are not recommended for high cholesterol as much anymore — it more has to do with the type of fat (plant based vs. animal based). Good luck!
Hi I am 43my wife 39 we both have cholesterol what is under control I taking 20 mg wife takes 40 mg Crestor my mom have and my wife mom have cholesterol to so my son 9year old have total cholesterol 477 (LDL 367). (Tri.58). (Hdl 59) my doctor send us cardiologist he put him diet and solo naison we both work in hospital lots of doctor told us take kids to USAF lipid panel I don’t know what should I do please any body let me know what would we do god bless you every one
You really need to ask your pediatrician about that. It’s out of my area of expertise. Good luck!
It my mistake doctor told us to take kids to UCSF lipid panel